Provider Demographics
NPI:1740305234
Name:PIDOT, WENDELL K (PT)
Entity type:Individual
Prefix:MR
First Name:WENDELL
Middle Name:K
Last Name:PIDOT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15683
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96830-5683
Mailing Address - Country:US
Mailing Address - Phone:808-593-4005
Mailing Address - Fax:808-591-2625
Practice Address - Street 1:1221 KAPIOLANI BLVD
Practice Address - Street 2:SUITE 6G
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814
Practice Address - Country:US
Practice Address - Phone:808-593-4005
Practice Address - Fax:808-591-2625
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT1990225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000232694OtherHMSA
0000232694OtherHMSA